Regular Breakfast Consumption and Type 2 Diabetes Risk Markers in 9- to 10-Year-Old Children in the Child Heart and Health Study in England (CHASE): A Cross-Sectional Analysis

et al. (2014) Regular Breakfast Consumption and Type 2 Diabetes Risk Markers in 9- to 10- Year-Old Children in the Child Heart and Health Study in England (CHASE): A Cross-Sectional Analysis. PLoS Med 11(9): e1001703. doi:10.1371/journal.pmed. 1001703 Regular Breakfast Consumption and Type 2 Diabetes Risk Markers in 9- to 10-Year-Old Children in the Child Heart and Health Study in England (CHASE): A Cross- Sectional Analysis Angela S. Donin 0 Claire M. Nightingale 0 Chris G. Owen 0 Alicja R. Rudnicka 0 Michael R. Perkin 0 Susan A. Jebb 0 Alison M. Stephen 0 Naveed Sattar 0 Derek G. Cook 0 Peter H. Whincup 0 Bruce P. Lanphear, Simon Fraser University, Canada 0 1 Population Health Research Institute, Division of Population Health Sciences and Education, St George's University of London , London , United Kingdom , 2 Nuffield Department of Primary Care Health Sciences, University of Oxford , Oxford , United Kingdom , 3 Medical Research Council Human Nutrition Research, Cambridge, United Kingdom, 4 Institute of Cardiovascular and Medical Sciences, University of Glasgow School of Medicine , Glasgow , United Kingdom Background: Regular breakfast consumption may protect against type 2 diabetes risk in adults but little is known about its influence on type 2 diabetes risk markers in children. We investigated the associations between breakfast consumption (frequency and content) and risk markers for type 2 diabetes (particularly insulin resistance and glycaemia) and cardiovascular disease in children. Methods and Findings: We conducted a cross-sectional study of 4,116 UK primary school children aged 9-10 years. Participants provided information on breakfast frequency, had measurements of body composition, and gave fasting blood samples for measurements of blood lipids, insulin, glucose, and glycated haemoglobin (HbA1c). A subgroup of 2,004 children also completed a 24-hour dietary recall. Among 4,116 children studied, 3,056 (74%) ate breakfast daily, 450 (11%) most days, 372 (9%) some days, and 238 (6%) not usually. Graded associations between breakfast frequency and risk markers were observed; children who reported not usually having breakfast had higher fasting insulin (percent difference 26.4%, 95% CI 16.6%-37.0%), insulin resistance (percent difference 26.7%, 95% CI 17.0%-37.2%), HbA1c (percent difference 1.2%, 95% CI 0.4%-2.0%), glucose (percent difference 1.0%, 95% CI 0.0%-2.0%), and urate (percent difference 6%, 95% CI 3%-10%) than those who reported having breakfast daily; these differences were little affected by adjustment for adiposity, socioeconomic status, and physical activity levels. When the higher levels of triglyceride, systolic blood pressure, and Creactive protein for those who usually did not eat breakfast relative to those who ate breakfast daily were adjusted for adiposity, the differences were no longer significant. Children eating a high fibre cereal breakfast had lower insulin resistance than those eating other breakfast types (p for heterogeneity ,0.01). Differences in nutrient intakes between breakfast frequency groups did not account for the differences in type 2 diabetes markers. Conclusions: Children who ate breakfast daily, particularly a high fibre cereal breakfast, had a more favourable type 2 diabetes risk profile. Trials are needed to quantify the protective effect of breakfast on emerging type 2 diabetes risk. Please see later in the article for the Editors' Summary. - Competing Interests: The authors have declared that no competing interests exist. Introduction The high prevalence of type 2 diabetes both globally and in the UK, which affects increasingly younger individuals [1], presents a major public health challenge [2]. Diet and eating patterns appear to play an important role in the aetiology of type 2 diabetes, though the importance of specific dietary components remains unresolved [2]. Breakfast is an important meal, providing appreciable proportions of daily energy, macronutrient, and micronutrient intakes [3]. In adults, skipping breakfast has been associated with higher risk of overweight and obesity [4,5] and with a higher risk of type 2 diabetes [6,7]. In young adults, skipping breakfast has been associated with an increased risk of the metabolic syndrome [8]. Breakfast content may also be important; studies in the US have shown that the consumption of breakfast cereal is associated with a more favourable risk factor profile for type 2 diabetes and cardiovascular disease [9]. Previous studies in children have shown consistent associations between skipping breakfast and higher body mass and obesity prevalence [10]. However, the influence of breakfast frequency on precursors of type 2 diabetes and cardiovascular disease in children have not been reported to date. Moreover, among children who do eat breakfast, the influence of breakfast content has been little studied. In addition, although studies have shown that children who report skipping breakfast have poorer diet quality, with lower energy intakes, higher energy density, saturated fat, and lower vitamin and mineral intakes [10], the contribution of these nutritional differences to differences in adiposity or diabetes risk remains uncertain. These questions are particularly important because recent evidence suggests that the prevalence of breakfast consumption has declined both in adults and children [11,12]. In the UK, these issues may be particularly relevant for children from ethnic minority groups (especially children of South Asian and black African-Caribbean origin) who are at increased risk of both type 2 diabetes and obesity [13] and may be less likely to eat breakfast every day [14]. We investigated the associations between breakfast consumption (both frequency and breakfast content) and risk markers for type 2 diabetes and cardiovascular disease in a large multi-ethnic population of children in order to test our main research hypothesis that both breakfast frequency and composition would be associated with type 2 diabetes risk markers in childhood, and particularly with insulin resistance and glycaemia, which are strongly related to the development of insulin resistance, hyperglycaemia, the metabolic syndrome, and type 2 diabetes in adult life [15]. In a subset of the study population with detailed dietary information, we also examined differences in dietary energy and nutrient intakes between children who regularly eat breakfast and those who do not, and their contribution to observed differences in risk markers for type 2 diabetes and cardiovascular disease. Ethics Statement Ethical approval was provided by the Multicentre Research Ethics Committee Wales. This investigation was based on the Child Heart And health Study in England (CHASE) [16], which examined risk markers for type 2 diabetes and cardiovascular disease risk and their determinants in a multi-ethnic population of children aged 910 years. Children of predominantly South Asian, black AfricanCa (...truncated)